Pembrolizumab and lenvatinib-associated pemphigoid-like dermatosis in advanced renal cell carcinoma: the hidden cost of synergy successfully managed with dupilumab – a case report

Immune-checkpoint inhibitors have reshaped the therapeutic armamentarium of advanced renal cell carcinoma while increasing the incidence of immune-related adverse events. Among these, bullous dermatoses are rare but potentially severe and therapeutically challenging. We report a case of pemphigoid-like dermatosis induced by pembrolizumab and lenvatinib in a patient affected by metastatic renal cell carcinoma. Initial management with systemic corticosteroids led to complete clinical remission; however, early relapse with vesiculobullous erythema required treatment escalation with the introduction of dupilumab. We discuss the underlying immunopathogenesis, differential diagnosis and multidisciplinary management strategies in accordance with current international guidelines and the literature. We also highlight the feasibility of effectively managing treatment-related cutaneous toxicity with dupilumab, allowing continuation of oncological therapy without compromising disease control. Multidisciplinary, tailoredpatient treatment workups remain the gold standard for the management of these toxicities. Download the Plain Language Summary of this article: https://www.drugsincontext.com/plain-language-summaries/plain-language-summary-pembrolizumab-and-lenvatinib-associated-pemphigoid-like-dermatosis-in-advanced-renal-cell-carcinoma-the-hidden-cost-of-synergy-successfully-managed-with-dupilumab This article is part of the Special Issue From evidence to the individual patient: pembrolizumab plus lenvatinib in real-world metastatic renal cell carcinoma: https://www.drugsincontext.com/special_issues/from-evidence-to-the-individual-patient-pembrolizumab-plus-lenvatinib-in-real-world-metastatic-renal-cell-carcinoma